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RA'Y'WEMT San Joaquin County-Environmental Health Department CE�VED 1868 E I lazelton Ave-Stockton CA 95205-Phone: 209468-3420 11 r APPLICATION CAN`OAQUI iV ENVIRONMENTAL PE MIT TO OPERATET li H EIyyIRONME'VZA Y EMPLOYEE HOUSING OR LABOR CAMPt ��PARTMENt ❑New Camp ❑Conditional Permit ❑ Multiple Years(Permanent Housing Camps only) ® Annual Permit for Calendar Year 2026 ❑Amended Permit: "Change of Operator "Change of Owner •Change of Operator Address "Change of Owner Address "Additional Employees State ID#: Please Note any Corrections or Changes in Facility/Operator Information directly on this form. Site Name: MACHADO DAIRY FARMS#2 39-351 Location: 19405 E.MARIPOSA RD STOCKTON' Operator: MACHADODAIRYFARMS#239-351 Ismail. 5;>Mpe, II01L) wt4A 'corn Mailing Address: PO BOX 4430,MANTECA CA 95337 Facility Phone#: (209)825-1913 Legal Owner: MACHADO,DONALD A AND JOHN A New Owner? ❑ Yes 0?90 Owner Address: PO BOX 4430,MANTECA CA 95337 Owner Phone#: (209)825-1913 Email. Community Facilities Provided by Camp: Community Kitchen? ❑ Yes ❑ No Slen: NumberofToilets AdAl Number of Showers N1,4Number of Lavatories A �Nonten: NumberofToilets NZ Number of Showers NSA Number of lavatories /Uya Housing Accommodations to be Utilized this Year: Occunancv Dates: Buildings Employees Dormitories � �_ from / / to / / Crop f f SF Dwellings _ from / / to / / Crop r, Apartments 2/ Owner Owned MH/RV 3 Total Number of Days to be used this Calendar Year: o�fO S Owner Owned RR Cars Total Days Occupied by 25 or more Employees: 44 MH/RV Spaces Note TOTALS Camps occupied by 25 or more Employees for 60 or more days in a year Require a PUBLIC WATER SYSTEM Permit ❑Inactive Important: In order to protect your land use status,if camp will not be used this year but is intended for use in the future,Check this Box and return this application. Fee Schedule Ord [� Permanent Camp Annual Permit Fee $54.00+ Number of Employees _ @$17.00 each=$ d Transferof Ownership $25.00=$ ❑ Permanent Amendment Fee $25.00+ Number of Additional Employees @$17.00 each=$ ❑ Late Application Fee $108.00+ Number of Employees @$34.00 each=$ Fee must be submitted with Application &a TOTAL FEE DUE$ U RemItTOTAL FEE as CALCULATED ABOVE in the ENCLOSED Self-addressed Envelope MAKE CHECKS PAYABLE to EHD Applicant agrees to all necessary inspections incident to issuance of a PERMIT TO OPERATE. Applicant agrees that this project(camp)shall be operated and maintained in accordance with the applicable provisions of the EMPLOYEE HOUSING ACT,Chapter 1,Part 1,Division 13 of the Califonda llealth and Safety Code and Chapter 1,Subchapter 3,Title 25,California Code o Regala bns. Applicant Name � . ^aC 4do Title fAQ.�I1+Ct/ [3]'Partnership (Please PRINT or TY ❑Corporation Address t t e1 Phone .209-6QZ-3Y2q Applicant Signature .�� Date of Application Amount Paid Date of Payment Payment Type Check/Receipt# Received By 190.bo S �l a 79310 Facility ID Program Record ID PIE Assigned to PM 10 I:�nun;J PROSISb_'I _"Iu astina Thantmavangsa Report 9 7067.rp[